Obama Open to Several GOP Healthcare Reform Ideas

WASHINGTON -- President Barack Obama, who will outline a plan for moving forward on healthcare reform Wednesday, told congressional leaders he would accept several Republican proposals.

It has been less than a week since Obama led a bipartisan healthcare summit, which served to highlight the vast differences in ideology between Republicans and Democrats. While the differences seemed to outnumber the similarities, Obama offered a more positive assessment:

"I also left convinced that the Republican and Democratic approaches to healthcare have more in common than most people think," he wrote to Speaker of the House Nancy Pelosi (D-Calif.), House Minority Leader John Boehner (R-Ohio), Senate Majority Leader Harry Reid (D-Nev.), and Senate Minority Leader Mitch McConnell (R-Ky).

It also appears likely that the plan will involve a controversial procedural move called reconciliation.

The House would likely approve a version of the Senate's Christmas Eve bill. Senators would then likely use reconciliation to modify their own bill, but it must be done carefully. According to Senate rules, reconciliation can only be used for measures that will effect the federal budget.

However, those changes would only require a normal 51-vote majority, and not the 60-vote supermajority that Republicans have imposed by repeated filibusters. Meanwhile, Obama said he was willing to accept some Republican ideas.

"No matter how we move forward, there are at least four policy priorities identified by Republican members at the meeting that I am exploring," Obama wrote.

The president said he is open to including $50 million in his proposal to fund demonstration projects to test alternatives to resolving medical malpractice disputes. The Department of Health and Human Services (HHS) is already in the process of awarding $23 million in such grants.

While many doctors favor implementing caps on malpractice awards, Obama has said he doesn't think caps are fair to patients who are severely harmed by a medical error.

Speaking to a members of the American Medical Association (AMA) on Tuesday, HHS Secretary Kathleen Sebelius said the president is "eager" to look at additional models aside from the traditional tort system.

But she said the "science" on whether caps really do help control broader medical costs is unclear.

"We believe that's an important part of staunching the flow of blood in regards to medical liability," he told MedPage Today. "We will continue to push for those. But we understand the president said it's not on the table for him."

Obama also said he'd consider a suggestion by Sen. Charles Grassley (R-Iowa), that Medicaid reimbursements to doctors should be increased because health reform would serve to enroll more people in Medicaid, and the program reimburses at lower rates than those of private insurance companies.

"I'm open to exploring ways to address this issue in a fiscally responsible manner," Obama said.

Obama said Sen. Tom Coburn (R-Okla.), an Ob/Gyn, made an "interesting suggestion" during the summit that the government should engage medical professionals to conduct random undercover investigations of providers that receive reimbursements from Medicare and Medicaid.

Lastly, Obama said he's open to a suggestion by Sen. John Barrasso (R-Wyo.) an orthopedic surgeon, to expand health savings accounts.

But Republicans were not appeased.

"Particularly encouraging was your apparent support at the summit for a number of commonsense ideas that Republicans have long promoted as a way of targeting the high cost of healthcare," Senate Minority Leader Mitch McConnell wrote in a response letter to the president.

"It was with this in mind that we were surprised and disappointed with your latest proposal to simply paper a few of these commonsense proposals over an unsalvageable bill."

Obama also detailed several provisions that his proposal would remove, saying that they "shouldn't have been" there in the first place.

For example, the president's proposal would remove the controversial "corn-husker kickback" which would have made the federal government responsible for covering Nebraska's Medicaid costs. The preferential treatment for Nebraska was part of the deal Sen. Ben Nelson (D-Neb.) struck with Senate Majority Leader Harry Reid.

With reconciliation requiring only a majority, Nelson's vote would no longer be necessary.

The president's proposal would also remove a provision that gives Florida a break from cuts to Medicare Advantage, the private plans available to seniors under Medicare.

"My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, healthcare experts, and everyday Americans -- not just last Thursday, but over the course of a yearlong dialogue," Obama wrote.

"After decades of trying, we're closer than we've ever been to making health insurance reform a reality."